The North West is the worst region in the country for hospital roofs built with a type of concrete that could suffer sudden collapse, the Manchester Evening News can reveal. The roofs with the material - including buildings at Salford Royal and the Royal Oldham hospitals - might not be fixed until 2035, NHS bosses have admitted.
Some 11 hospital buildings across the North West have been built with concrete that has prompted concerns of the risk of cracking and collapse from government bodies, safety groups and politicians alike. The roofs are built with reinforced autoclaved aerated concrete (RAAC), which is a lightweight, cheaper form of material - it has been compared to a "chocolate Aero bar" and slammed as a "ticking time bomb" by one NHS chief executive.
The seven hospitals in the North West with roofs which use RAAC are: Aintree, Leighton, Blackpool, Countess of Chester, Royal Blackburn, the Royal Oldham, and Salford Royal. Current government plans would not see removal of this concrete from all affected hospitals for another 13 years.
In late 2018, the Local Government Association (LGA) and the Department for Education (DfE) contacted all school building owners to draw attention to the failure of two school roofs constructed using RAAC planks. There was little warning of the sudden collapses, the LGA reported: "The limited durability of RAAC roofs has long been recognised; however recent experience (which includes two roof failures with little or no warning) suggests the problem may be more serious than previously appreciated and that many building owners are not aware that it is present in their property."
Since then, government advice has been issued on how organisations should deal with the risk posed by the building material, with the LGA and DfE urging responsible bodies to 'confirm the safety of RAAC construction' as 'many RAAC buildings are now at least 38 years old'. A 2021 DfE guide on how to identify and take action on RAAC roofs read: "RAAC is less strong than traditional concrete and there have been problems as a result, which could have significant consequences."
The information about the seven North West hospitals was revealed by a Freedom of Information request from the Liberal Democrats. Asked by the party when the NHS aims to have all RAAC removed from hospital roofs, NHS England responded that it would not happen until 2035. Questions over how much it will cost were rebuffed by the organisation, which said 'it does not hold that information'.
The stated average lifespan of a RAAC is approximately 30 years. Following the collapse of the school roof, a national alert was raised in 2019, by buildings and engineering safety body CROSS (Collaborative Reporting For Safer Structures UK), to emphasise the potential risks. The material was used primarily in roof planks of some public buildings built between the mid-1960s and mid-1990s.
'It is very different to traditional concrete'
The CROSS alert in 2018 suggested NHS trusts should take 'interest' at the time, saying: "Although the failure was in a school, it is believed that RAAC planks are present in many types of buildings. This alert is to emphasise the potential risks from such construction, most of which dates back to between the 1960-80s.
"Although called “concrete”, it is very different from traditional concrete and, because of the way in which it was made, much weaker. The useful life of such planks has been estimated to be around 30 years. Pre-1980 RAAC planks are now past their expected service life and it is recommended that consideration is given to their replacement."
"Problems with RAAC roof planks have been known about since the early 1990s," continued the alert. "In many buildings, the planks have been replaced with alternative structural roofs or the spans have been shortened by the introduction of secondary supports, but others will remain and may pose risks.
"The partial collapse that occurred in 2018 was at a weekend so the school was fortunately unoccupied. In structural safety terms it was a near miss. Similarly, in the case of the Edinburgh School masonry collapse in 2016, this occurred in the early morning when no pupils were present.
"In either case, the consequences could have been more severe, possibly resulting in injuries or fatalities. There is therefore a risk, although its extent is uncertain.
"The risk must be identified by locating buildings where RAAC planks are present and assessing their condition and structural adequacy. If there is doubt about the structural adequacy of the planks, then it is recommended that consideration is given to their replacement."
'Continual monitoring' at Salford and Oldham
In Greater Manchester, the concrete was found in the roof in the main building at Royal Oldham and in the roof of Turnberg Building at Salford Royal, the Northern Care Alliance NHS Foundation Trust (NCA), which runs the two hospitals, has confirmed. The trust has stated that the planks in the hospital buildings it operates are currently in good condition, but will be removed as part of the national efforts to replace the material by 2035.
Andrew Montgomery, Deputy Director of Estates, Facilities & Capital Development, at the NCA said: “The planks in both buildings have been inspected as part of a national requirement for all NHS Trusts to monitor and identify any issues. The planks have been structurally assessed as being in a good condition and will be continually monitored using a range of assessment technologies. NHS England has committed to fully removing RAAC planks from the NHS estate by 2035.”
"Patient and staff safety are paramount, and alongside ongoing inspections, the NCA has a rolling programme of additional surveillance to ensure any issues are found and fixed quickly until the planks have been replaced. No or minimal disruption to services is expected during these ongoing inspections."
Hospital in Cambridgeshire had to bring in an 18 stone limit on patients in some rooms
Outside the region, chief executives have admitted that the roof problems at their hospitals are causing disruptions to patients. Thirty buildings at 20 different hospitals run by 18 individual NHS trusts have between one and four RAAC roofs, according to NHS England.
One NHS chief executive of a hospital near Prime Minister Liz Truss’s constituency likened the material to a “chocolate Aero bar” with "bubbles" that could break and collapse at any point. Speaking to the Sunday Times earlier this year, the chief executive of Queen Elizabeth Hospital in King's Lynn, Caroline Shaw, shared how the roof has 1,500 steel props holding up its roofs in 56 areas.
She said: "The roof is like a chocolate Aero bar. There are bubbles in the concrete and we're checking it daily to make sure those bubbles don't break and the roof doesn't come down. It really is like a ticking time bomb.
"We quite often have to move services around to enable us to prop up the roof and I think for patients who are lying in bed and seeing these props it does feel quite unsafe and we have had patients complain about this."
For Hinchingbrooke Hospital in Huntingdon, Cambridgeshire, the poor condition of the main theatres posed a significant risk to elective care.
North West Anglia NHS Foundation Trust wrote in its annual plan, published in June: “There are a number of building-related issues, the most significant being the RAAC [reinforced autoclaved aerated concrete] panelling, which affects the loadbearing of the floor, restricting the use of some theatres to patients under 120kg.”
'We need urgent investment in our local health services'
Politicians across the country have taken up the cause, with the issue raised by multiple MPs in Westminster. In June 2021, Conservative Keighley MP Robbie Moore told the Commons that 'time is of the essence' for Airedale Hospital in West Yorkshire, saying: "While many of these 1960s constructions have come and gone, Airedale Hospital remains. It is thought to be the oldest aerated concrete hospital in the UK. Aerated concrete is present in the roof and walls and the hospital is the only NHS trust asset that has aerated concrete in its floor panels. In fact, in total the hospital has over 50,000 aerated concrete panels, which is five times more than any other hospital affected by reinforced aerated concrete design.
"Aerated concrete is known to have about one 20th of the strength of normal concrete. The Building Research Establishment has identified that aerated concrete roof panels are prone to fail when deflections between 50 mm and 90 mm come about. It is deeply concerning that Airedale Hospital has identified a significant number of aerated concrete panels with deflections approaching that threshold."
In July 2021, Tory Health Minister Edward Argar told the Commons that the 2020 spending review included £110m given to one hospital 'for the most serious and immediate risk posed by reinforced autoclaved aerated concrete'.
Meanwhile, in March of this year, fellow Tory and North West Norfolk MP James Wild also raised concerns about the Queen Elizabeth Hospital: "This is a serious situation, and the trust’s risk register has a red rating for direct risk to life and the safety of patients, visitors and staff, due to the potentially catastrophic risk of failure of the roof structure. Last year, the critical care unit had to close for some weeks due to precisely those safety issues."
Although Greater Manchester's hospitals insist their RAAC is in good condition, Stockport Liberal Democrat Councillor and member of the Health and Adult Social Care Scrutiny Committee Lisa Smart still fears that the region's hospitals could imminently collapse. She told the M.E.N.: “It is unacceptable that people are being treated in hospitals with roofs which could collapse at any moment.
“The new Secretary of State of Health must provide urgent funding to replace these dangerous roofs before it's too late. Here in Hazel Grove and across the North West people are being totally ignored by this Conservative Government.
"Our ambulance waiting times are already at dangerous levels and now local hospitals are crumbling. We need urgent investment in our local health services before more patients are left to suffer from an overstretched and underfunded NHS.”
In the 2019 alert, CROSS did warn of imminent structural failure that could come without signs: "Sight must not be lost of the fact that the 2018 collapse was sudden with very little noticeable warning. This is indicative of shear failure in cementitious materials and can only be protected against by knowing that there is sufficient shear resistance in the material, the reinforcement, or both.
"In a reminder, the LGA and the DfE stated that the condition of all buildings should be regularly monitored, taking a risk based approach that gives due deliberation to the use of the building with consideration given to the possible impact of reduced maintenance."
The Institute of Structural Engineers produced a report in March 2022 which urged that investigations and assessments of RAAC buildings should be carried out as older RAAC panels are 'are not performing as expected and structural deficiencies are apparent. Some of these defects can reduce structural integrity'. Not all defects are visible, meaning the nature of any warning signs of sudden failure cannot be known, added the institute.
A Department of Health and Social Care spokesperson said: “The government is publicly committed to eradicating RAAC from the NHS estate by 2035 and protecting patient and staff safety in the interim period, with the NHS approaching this on a risk basis prioritising NHS Trusts of concern.
“We are providing more than £4 billion for trusts to support local priorities, including to maintain and refurbish their premises, as well as over £685 million to directly address urgent risks relating to the use of Reinforced Autoclaved Aerated Concrete (RAAC) in the NHS estate.”
But politicians on the other side of the Commons have called it a 'national scandal' that should be rectified immediately. Liberal Democrat Health spokesperson Daisy Cooper MP said: “This is a disaster waiting to happen and Conservative ministers just don’t seem to care. It is a national scandal that successive health ministers have not even bothered to replace dangerous roofs which put patients and staff at risk.
“The Government should apologise to dedicated nurses and doctors who for too long have worked in fear that the roof may collapse at any moment.”
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